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Luo S, Hu X, Hong Y, Gao Y, Liu X, Peng Y, Tong X, Zhang X, Wen J. Risk Factors for Post-Stroke Depression Following the Lifting of COVID-19 Restrictions. Int J Gen Med 2024; 17:3479-3491. [PMID: 39161406 PMCID: PMC11331147 DOI: 10.2147/ijgm.s472339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024] Open
Abstract
Purpose Research on post-stroke depression (PSD) following the lifting of coronavirus disease 2019 (COVID-19) restrictions remains sparse. This study aimed to investigate the factors associated with PSD after the easing of COVID-19 restriction measures. Patients and Methods This cross-sectional study was conducted with 947 stroke patients (cerebral hemorrhage and cerebral infarction) meeting the inclusion criteria. Participants completed a demographic questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Additionally, data were collected on C-reactive protein (CRP), homocysteine (Hcy), modified Rankin Scale (mRS), stroke site, National Institutes of Health Stroke Scale (NIHSS), thyroid-stimulating hormone (TSH), and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. This study assessed correlations between these indices and PSD. Results Stroke patients with a PHQ-9 score ≥5 were identified as having PSD, with a prevalence rate of 14.15%. No significant correlation was found between previous COVID-19 infection and PSD. However, multiple regression analysis revealed associations between PSD and the following factors: TSH (OR: 0.87, 95% CI: 0.76-1), CRP levels (OR: 1.01, 95% CI: 1-1.02), family history of stroke (OR: 4.25, 95% CI: 1.66-10.88), migraine history (OR: 8.63, 95% CI: 2.49-29.85), and shorter sleep duration (OR: 0.6, 95% CI: 0.51-0.71) (all P < 0.05). Conclusion CRP, family history of stroke, migraine, sleep duration, and TSH are identified as independent risk factors for PSD following the lifting of COVID-19 restrictions.
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Affiliation(s)
- Shangyu Luo
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Xueqin Hu
- Department of Neurosurgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Yunjun Hong
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Yunchun Gao
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Xianglin Liu
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Yu Peng
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Xueqing Tong
- Department of Brain Electrophysiology, Changde Hospital, Xiangya School of Medicine, Central South University (The first People’s hospital of Changde city), Changde City, Hunan Province, People’s Republic of China
| | - Xiaobo Zhang
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
| | - Jun Wen
- Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde City, Hunan Province, People’s Republic of China
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Fama ME, Schwartzman S, Metzler E, Coyle S, Hatfield B. Self-reported longitudinal impacts of the COVID-19 pandemic on adults with acquired communication disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-12. [PMID: 39126168 DOI: 10.1080/17549507.2024.2364807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
PURPOSE Adults with acquired communication disorders are particularly vulnerable to potential negative effects from the changes that arose during the COVID-19 pandemic. In this longitudinal study, we asked: How did the self-perceived impacts of the pandemic on adults with acquired communication disorders change over time? METHOD We developed an online survey to investigate changes in day-to-day behaviours, psychosocial elements, and communication abilities among members of a community-based stroke recovery centre in the USA. Participants included adults with aphasia or other cognitive-communication disorder from stroke or brain injury. We compared survey responses from summer 2020 (n = 50) and summer 2021 (n = 24) using a concurrent mixed methods design. RESULT The impacts of the pandemic changed over time. By 2021, participants reported a more "normal" amount of time spent on in-person socialising and healthcare, improved quality of life and connectedness to others, and an improvement in overall communication ability. Across both years, participants shared comments regarding changes in routine, increased use of technology, and the positive benefit of therapy groups. CONCLUSION Self-perceived psychosocial elements and communication abilities among stroke and other brain injury survivors changed over the course of the pandemic. Clinicians and researchers should continue providing this population with support and opportunities for engagement.
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Affiliation(s)
- Mackenzie E Fama
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
| | - Sabrina Schwartzman
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
| | - Emma Metzler
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
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Alsabhan J, Alanazi A, Alhajaji R, Elbashir M, Alzahrani F, Alhajaji F, Almehmadi M, Alqorashi S, Ahmed Fairaq B, Alhazmi F. Common Mental Health Disorders and Their Current Prescription Patterns in Saudi Arabia's Primary Healthcare Settings. Cureus 2024; 16:e65562. [PMID: 39192909 PMCID: PMC11348274 DOI: 10.7759/cureus.65562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Background The mental healthcare program is widely implemented in primary healthcare settings in Saudi Arabia. It consisted of early screening and management of mental health disorders associated with chronic health conditions. Family physicians are authorized to prescribe selective serotonin reuptake inhibitors (SSRIs) for early management of mental health disorders in primary healthcare centers (PHCs). The aim of the study is exploring the prevalence of various types of mental health disorders and to assess the prescribing pattern of SSRIs in PHCs. Materials and methods A cross-sectional study based on the data from electronic health records, telephone interviews, and prescriptions of individuals administered SSRIs at PHCs. Results Among 219 patients visiting PHCs, 67.6% were female participants. Forty-four percent of the patients were 20-30 years old and 61.2% of them received SSRI medications. The most prevalent chronic condition was diabetes (22.5%) followed by hypertension (20.5%) and asthma (6.4%). The most prevalent mental disorder was major depressive disorder (MDD; 78.1%), followed by anxiety disorder (7.3%), panic disorder (6.4%), and MDD with anxiety disorders (5.5%). Conclusion Implementing mental healthcare programs in PHCs is believed to promote population health. MDD was the predominant mental health disorder among patients visiting PHCs, and SSRIs were the most prescribed medications in this setting. This suggests that mental healthcare programs in PHCs are effective in improving mental health outcomes.
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Affiliation(s)
| | - Ashwaq Alanazi
- Second Health Cluster, King Fahad Medical City, Riyadh, SAU
| | - Raghad Alhajaji
- Public Health Department, Ministry of Health, Makkah, SAU
- Alhajj Primary Health Care, Primary Care Department, Makkah Health Cluster, Makkah, SAU
| | - Malaz Elbashir
- Infectious Disease Department, Public Health Administration, Ministry of Health, Makkah, SAU
| | - Faisal Alzahrani
- School Health Department, Public Health Administration, Ministry of Health, Makkah, SAU
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Taylor ER, Estevao C, Jarrett L, Woods A, Crane N, Fancourt D, Pariante C, Jones F. Experiences of acquired brain injury survivors participating in online and hybrid performance arts programmes: an ethnographic study. Arts Health 2024; 16:189-205. [PMID: 37395661 DOI: 10.1080/17533015.2023.2226697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 06/09/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Performance arts can benefit people with acquired brain injury (ABI). This study explored the online delivery during COVID-19 restrictions, of a performance art intervention through the experiences of participants, artists and facilitators. METHODS Two community-based programmes were delivered. Online ethnographic observations and semi-structured interviews with participants, artists and facilitators were completed. RESULTS The programmes benefited participants by addressing loneliness and isolation; building confidence through peer support; improving physical limitations through movement; improving communication through music and vocal work; and using poetry, visual arts, metaphor and performance to make sense of participants' experiences. Participants had mixed experiences of participation, but it was an acceptable alternative to in-person arts interventions for those who overcame digital challenges. CONCLUSIONS ABI survivors can engage in online performance art programmes and find participation valuable for their health, well-being, and recovery. More work is needed to explore the generalisability of these findings, especially given digital poverty.
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Affiliation(s)
| | - Carolina Estevao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, UK
| | | | - Anthony Woods
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, UK
| | - Nikki Crane
- Arts, Health and Wellbeing, Culture Team, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, UK
| | - Fiona Jones
- Institute of Population Health, St George's, University of London, London, UK
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Li Y, Wang Y, Gao L, Meng X, Deng Q. Effect of nonpharmacological interventions on poststroke depression: a network meta-analysis. Front Neurol 2024; 15:1376336. [PMID: 38645742 PMCID: PMC11027129 DOI: 10.3389/fneur.2024.1376336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To investigate the effects of nonpharmacological interventions (NPIs) on poststroke depression (PSD) in stroke patients. Methods Computer searches were conducted on the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to December 2023. The selection was made using the inclusion and exclusion criteria, and 40 articles were included to compare the effects of the 17 NPIs on patients with PSD. Results Forty studies involving seventeen interventions were included. The network findings indicated that compared with conventional therapy (COT), superior PSD improvement was observed for cognitive behavioral therapy (CBT) + acupoint acupuncture (CBTA) (mean difference [MD], -4.25; 95% CI, -5.85 to -2.65), team positive psychotherapy (MD, -4.05; 95% CI, -5.53 to -2.58), music therapy (MT) + positive psychological intervention (MD, -2.25; 95% CI, -3.65 to -0.85), CBT (MD, -1.52; 95% CI, -2.05 to -0.99), mindfulness-based stress reduction (MD, -1.14; 95% CI, -2.14 to -0.14), MT (MD, -0.95; 95% CI, -1.39 to -0.52), acupoint acupuncture + MT (AAMT) (MD, -0.69; 95% CI, -1.25 to -0.14). Furthermore, CBT (MD, -3.87; 95% CI, -4.57 to -3.17), AAMT (MD, -1.02; 95% CI, -1.41 to -0.62), acupressure + MT (MD, -0.91; 95% CI, -1.27 to -0.54), and narrative care + acupressure (MD, -0.74; 95% CI, -1.19 to -0.29) demonstrated superior Pittsburgh Sleep Quality Index (PSQI) improvement compared with COT. Conclusion Evidence from systematic reviews and meta-analyses suggests that CBTA improves depression in patients with PSD. Moreover, CBT improves sleep in these patients. Additional randomized controlled trials are required to further investigate the efficacy and mechanisms of these interventions.
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Affiliation(s)
- Ying Li
- College of Sports Science, Jishou University, Jishou, China
| | - Yuanyuan Wang
- Cardiac Care Unit, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Gao
- School of Nursing, Dalian University, Dalian, China
| | - Xiaohan Meng
- College of Sports Science, Jishou University, Jishou, China
| | - Qidan Deng
- Department of Intensive Care Unit, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
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Soluk Özdemir Y, Paker N, Şişmanoğlu Ataç N, Buğdaycı D, Öneş K. COVID-19-related anxiety and obsession levels in stroke patients and family caregivers and their effects on caregiver burden. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:24-31. [PMID: 38315321 DOI: 10.1007/s40211-024-00490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE The aim of this study is to describe coronavirus disease 2019 (COVID-19)-related dysfunctional anxiety and thinking in patients with stroke and caregivers who are family members and their effects on caregiver burden. METHODS This cross-sectional study included 79 stroke patients and their primary caregivers who were hospitalised in a tertiary rehabilitation hospital. Coronavirus Anxiety Scale (CAS) and Obsession with COVID-19 Scale (OCS) were used to assess the levels of COVID-19-related dysfunctional anxiety and obsession of the patients and their caregivers. Caregiver burden was assessed via the Zarit Burden Interview (ZBI). RESULTS In the patients with stroke, COVID-19-related anxiety and COVID-19-related obsession rates were 13.9% (n = 11) and 7.6% (n = 6), respectively, while 17.7% (n = 14) of caregiver family members had COVID-19-related anxiety and 11.4% (n = 9) had COVID-19-related obsession. The CAS score of caregivers showed a significant positive correlation with the CAS and OCS scores of patients (p = 0.000, r = 0.423; p = 0.007, r = 0.300, respectively). The OCS score of caregivers showed a significant positive correlation with the OCS scores of the patients (p = 0.000, r = 0.476). The mean ZBI score of caregiver family members was 31.9 ± 13.5. A significant positive correlation was observed between the caregiver's OCS and CAS scores and ZBI scores (p = 0.002, r = -0.349; p = 0.004, r = 0.323, respectively). CONCLUSION In this study, a significant relationship between caregiver burden and COVID-19-related anxiety and obsession in the caregivers of stroke patients was identified. Therefore, caregivers of stroke patients should not be forgotten during pandemics and should receive physical and psychological support.
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Affiliation(s)
- Yelda Soluk Özdemir
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey.
| | - Nurdan Paker
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Nazlı Şişmanoğlu Ataç
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Derya Buğdaycı
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Öneş
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
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Fu J, Zhao Q, Li J, Chen X, Peng L. Association between thyroid hormone levels in the acute stage of stroke and risk of poststroke depression: A meta-analysis. Brain Behav 2024; 14:e3322. [PMID: 38189637 PMCID: PMC10751399 DOI: 10.1002/brb3.3322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/10/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Thyroid hormones have been indicated to be associated with depression, but their relationship with poststroke depression (PSD) remains controversial. Therefore, we performed a meta-analysis to explore the correlation between thyroid hormone levels in acute stroke and PSD. METHODS We searched databases for eligible studies. Standard mean differences (SMD) and 95% confidence intervals (CI) were applied to evaluate the association among levels of thyroid hormones, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), in acute stroke patients and the risk of PSD. RESULTS A total of 13 studies were included in the analysis. Compared to non-PSD patients, PSD patients had remarkably lower serum TSH and FT3 levels (TSH: SMD = -0.59, 95%CI = -1.04 to -.15, p = .009; FT3: SMD = -0.40, 95%CI = -.51 to -.30, p = .000) and higher serum FT4 levels (SMD = 0.33, 95%CI = .07-.59, p = .013). Subgroup analysis showed that there may be a more statistically significant association between FT3 and the risk of PSD compared to TSH and FT4. CONCLUSIONS Our results suggested that patients with lower serum TSH and FT3 levels as well as higher serum FT4 levels in the acute stage of stroke may be more susceptible to PSD.
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Affiliation(s)
- Jie Fu
- Department of NeurologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouSichuanChina
| | - Qin Zhao
- Department of NeurosurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhou SichuanChina
| | - Jinglun Li
- Department of NeurologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouSichuanChina
| | - Xiu Chen
- Department of NeurosurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhou SichuanChina
| | - Lilei Peng
- Department of NeurosurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhou SichuanChina
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Zhou H, Kulick ER. Social Support and Depression among Stroke Patients: A Topical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7157. [PMID: 38131709 PMCID: PMC10743211 DOI: 10.3390/ijerph20247157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Research has shown a protective association between social support and depression, depression among stroke patients, and health impacts of depression. Despite this, not much is known about the effect of social support on depression among stroke patients. This review aims to summarize the current research examining the association between social support and depression among stroke patients. A literature search was performed in PubMed to find original peer-reviewed journal articles from 2016 to 12 March 2023 that examined the association between social support and depression among stroke patients. The search terms were depression and "social support" and stroke, which lead to 172 articles. After abstract review, seven observational studies that studied the target association among stroke patients were selected. One additional study was found using PsycINFO as a complementary source with the same search strategy and criteria. Overall, a negative association was found between social support and depression among stroke patients in eight studies, with more social support leading to lower rates of depression post-stroke. The other study did not find a statistically significant association. Overall, the results of recent studies suggest that social support is negatively associated with depression among stroke patients. In most studies, this association was statistically significant. The findings suggest the importance of improving social support perceived by stroke patients in the prevention of depression after the occurrence of stroke.
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Affiliation(s)
| | - Erin R. Kulick
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA 19122, USA;
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Lam Ching W, Li HJ, Guo J, Yao L, Chau J, Lo S, Yuen CS, Ng BFL, Chau-Leung Yu E, Bian Z, Lau AY, Zhong LL. Acupuncture for post-stroke depression: a systematic review and network meta-analysis. BMC Psychiatry 2023; 23:314. [PMID: 37143014 PMCID: PMC10161596 DOI: 10.1186/s12888-023-04749-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Patients with post-stroke depression (PSD) usually experience anxiety, hopelessness, and insomnia, which have a negative impact on their daily activities and post-stroke rehabilitation. Acupuncture (AC), as a minimally invasive technique, has become a popular choice for improving depression symptoms. However, it is still unclear which therapy is associated with the best outcomes for PSD. In this review, we aimed to explore the impact of AC in alleviating symptoms of PSD and to evaluate the difference in effectiveness between AC combined with pharmacotherapies and various non-pharmacotherapies. METHODS Six databases and three clinical trials registration platforms were searched from inception to March 2023. Randomized clinical trial comparing needle-based AC with pharmacotherapy, and other non-pharmacotherapy or invalid group were included. Two independent reviewers identified eligible studies, and collected data using a pre-made form. A Bayesian network meta-analysis was conducted to assess and compare different techniques using RStudio 3.6.0 with the package 'GEMTC' V.0.8.1. The primary outcome was the efficacy for PSD assessed by scales measuring depressive symptoms. The secondary outcomes were effectiveness for neurological function and the quality of life. The ranking probabilities for all treatment interventions was performed using the Surface Under the Cumulative Ranking curve (SUCRA). The risk of bias was assessed by using the Revised Cochrane Risk of Bias tool 2. RESULTS Sixty-two studies, involving 5308 participants published from 2003 to 2022, were included. The results showed that compared with western medicine (WM) (defined as pharmacotherapy for PSD), AC alone or with repetitive transcranial magnetic stimulation (RTMS), Traditional Chinese medicine (TCM) alone or with WM, were superior for alleviating depression symptoms. Compared to Usual Care, AC alone or plus other therapies could significantly decrease scores on the Hamilton Depression Rating scale. According to result of SUCRA, AC plus RTMS had the highest probability of improving depressive symptoms with a probability of 49.43%. CONCLUSIONS The results of this study indicate that AC alone or combined with other therapies appears to be effective in improving depression symptoms of stroke survivors. Moreover, in comparison to WM, AC alone or plus RTMS, TCM, TCM with WM, or WM, were more effective in improving depression symptoms of PSD. Also, AC with RTMS seems to be the most effective with the highest probability. REGISTRATION This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database in November 2020 and updated in July 2021. The registration number is CRD42020218752.
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Affiliation(s)
- Wai Lam Ching
- Biomedical Sciences and Chinese Medicine, School of Biological Sciences, Nanyang Technological University, Singapore, 637551, Singapore
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Hui Juan Li
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Jianwen Guo
- Brain Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong University of Chinese Medicine, Guangzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Janita Chau
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Ma Liu Shui, Hong Kong SAR, China
| | - Suzanne Lo
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Ma Liu Shui, Hong Kong SAR, China
| | - Chun Sum Yuen
- School of Chinese medicine, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Bacon Fung Leung Ng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Edwin Chau-Leung Yu
- Hong Kong Association for Integration of Chinese-Western Medicine Limited, Kowloon, Hong Kong SAR, China
| | - Zhaoxiang Bian
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Alexander Y Lau
- Department of Medicine and Therapeutics and Hong Kong Institute of Integrative Medicine, Prince of Wales Hospital, Faculty of Medicine, the Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China.
| | - Linda Ld Zhong
- Biomedical Sciences and Chinese Medicine, School of Biological Sciences, Nanyang Technological University, Singapore, 637551, Singapore.
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China.
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Zhu Q, Chen L, Xu Q, Xu J, Zhang L, Wang J. Association between obstructive sleep apnea and risk for post-stroke anxiety: A Chinese hospital-based study in noncardiogenic ischemic stroke patients. Sleep Med 2023; 107:55-63. [PMID: 37119621 DOI: 10.1016/j.sleep.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This study explored the role of obstructive sleep apnea (OSA) in post stroke anxiety (PSA) in noncardiogenic ischemic stroke patients. METHODS 180 patients with noncardiogenic ischemic stroke were consecutively enrolled from January 2019 to December 2019. All patients underwent polysomnography (PSG) to assess for OSA. OSA severity was identified based on the apnea hypopnea index (AHI), i.e., no OSA (AHI <5), mild OSA (5 = AHI <15), and moderate to severe OSA (AHI ≥15). Neuropsychological assessments were performed at acute phase and 6 months later to evaluate anxiety (Chinese version of the Zung self-rating anxiety scale [SAS], and Beck Anxiety Inventory [BAI]), depression (Patient Health Questionnaire-9, [PHQ-9]), and cognition (Mini-mental state examination, [MMSE], and Montreal Cognitive Assessment, [MOCA]). Clinical diagnoses of PSA were made based on interviews and the anxiety scales. The correlations between PSA and OSA were investigated in Logistic regression analysis. RESULTS The prevalence of acute-phase and 6-month PSA were 27 (15%) and 52 (28.9%) respectively. Moderate to severe OSA and post-stroke depression (PSD) were the influencing factors of acute-phase PSA. 6-Month PSA was not associated with OSA but was associated with acute-phase anxiety, education status and MOCA. Logistic regression analysis including respiratory and sleeping parameters showed that AHI and micro-arousal index contributed to acute-phase PSA. CONCLUSIONS Acute-phase PSA was associated with OSA severity, potentially through OSA-caused sleep discontinuity. While 6-month PSA was associated with acute-phase anxiety, highlighting the need for integration of screening for and management of OSA and PSA at acute phase.
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Affiliation(s)
- Qiongbin Zhu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Leihui Chen
- Department of Internal Medicine, The Wuyun Mountain Hospital of Hangzhou(The Health Promotion Institute of Hangzhou), Hangzhou, Zhejiang, China
| | - Qinglin Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiahui Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Elias S, Benevides ML, Pereira Martins AL, Martins GL, Sperb Wanderley Marcos AB, Nunes JC. In-Hospital Symptoms of Depression and Anxiety are Strong Risk Factors for Post-Stroke Depression 90 Days After Ischemic Stroke. Neurohospitalist 2023; 13:121-129. [PMID: 37064927 PMCID: PMC10091427 DOI: 10.1177/19418744221132675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) and depression are the major causes of disability and decreased quality of life worldwide. Psychiatric disorders are common after stroke, especially post-stroke depression (PSD), which affects one-third of survivors. Although frequent, little is known about the real complexity of the pathophysiology and the factors associated with PSD. Methods This research aimed to provide data about risk factors and predictors of PSD 90 days after AIS. A cohort study was conducted in a tertiary stroke center located in southern Brazil. We interviewed 148 patients with AIS who were consecutively hospitalized between January 2020 and January 2021. The Hospital Anxiety and Depression Scale (HADS) was applied during hospitalization and at follow-up 90 days after AIS. Furthermore, sociodemographic, clinical, and radiological variables were investigated. Predictive factors were assessed using univariate and multivariate linear regression. The impact of the COVID-19 pandemic on the data was also evaluated. Results The frequency of PSD 90 days after AIS was 33.9%. In-hospital symptoms of depression and anxiety each represented a 2-fold risk for PSD at follow-up. Furthermore, the HADS - anxiety score 90 days after AIS was strongly associated with the HADS - depression value 90 days after stroke (R: .71; B: .56; P < .01). Conclusions The present study highlighted a noteworthy frequency of PSD 90 days after AIS. Psychiatric variables during hospitalization and in the follow-up appeared to be the leading associated factors with PSD. These data might support the determination of which patients require more psychiatric management.
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Affiliation(s)
- Stefany Elias
- University of Southern Santa
Catarina, Santa Catarina, Brazil
| | | | | | - Gladys Lentz Martins
- Department of Neurology, Hospital Governador Celso Ramos
(HGCR), Florianópolis, Brazil
| | - Ana Beatriz Sperb Wanderley Marcos
- Department of Medical Sciences,
Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
| | - Jean Costa Nunes
- Department of Pathology, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
- Neurodiagnostic Brasil – Diagnósticos
em Neuropatologia, Florianópolis, Brazil
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12
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Zhang H, Ma J, Sun Y, Xiao LD, Yan F, Tang S. Anxiety subtypes in rural ischaemic stroke survivors: A latent profile analysis. Nurs Open 2023; 10:4083-4092. [PMID: 36807562 PMCID: PMC10170921 DOI: 10.1002/nop2.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
AIM To determine the potential profile classes of anxiety reported by ischaemic stroke survivors in rural China, and to explore the characteristics of patients having different types of post-stroke anxiety. DESIGN A cross-sectional survey. METHODS A cross-sectional survey was conducted by using convenience sampling to collect data from 661 ischaemic stroke survivors in rural Anyang city, Henan Province, China, from July 2021 to September 2021. The parameters included in the study were the socio-demographic characteristics, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and the Barthel index of daily activity ability. Potential profile analysis was done to recognize subgroups of post-stroke anxiety. The Chi-square test was performed to explore the characteristics of individuals with different types of post-stroke anxiety. RESULTS The model fitting indices of stroke survivors supported three classes of anxiety models which were as follows: (a) Class 1, low-level, stable group (65.3%, N = 431); (b) Class 2, moderate-level, unstable group (17.9%, N = 118) and (c) Class 3, high-level, stable group (16.9%, N = 112). The risk factors associated with post-stroke anxiety were female patients, lower levels of education, living alone, lower monthly household income, other chronic diseases, impaired daily activity ability and depression. CONCLUSIONS This study identified three different subgroups of post-ischaemic stroke anxiety and their characteristics in patients in rural China. IMPACT This study has significance in providing evidence for the development of targeted intervention measures to reduce negative emotions in different subgroups of post-stroke anxiety patients. PATIENT OR PUBLIC CONTRIBUTION In this study, the researchers arranged the time of questionnaire collection with the village committee in advance, gathered the patients to the village committee for face-to-face questionnaire survey and collected the household data of the patients with mobility difficulties.
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Affiliation(s)
- Huimin Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Junyan Ma
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Yuyan Sun
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Fang Yan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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13
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Pagonabarraga J, Álamo C, Castellanos M, Díaz S, Manzano S. Depression in Major Neurodegenerative Diseases and Strokes: A Critical Review of Similarities and Differences among Neurological Disorders. Brain Sci 2023; 13:brainsci13020318. [PMID: 36831861 PMCID: PMC9954482 DOI: 10.3390/brainsci13020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Depression and anxiety are highly prevalent in most neurological disorders and can have a major impact on the patient's disability and quality of life. However, mostly due to the heterogeneity of symptoms and the complexity of the underlying comorbidities, depression can be difficult to diagnose, resulting in limited recognition and in undertreatment. The early detection and treatment of depression simultaneously with the neurological disorder is key to avoiding deterioration and further disability. Although the neurologist should be able to identify and treat depression initially, a neuropsychiatry team should be available for severe cases and those who are unresponsive to treatment. Neurologists should be also aware that in neurodegenerative diseases, such as Alzheimer's or Parkinson's, different depression symptoms could develop at different stages of the disease. The treatment options for depression in neurological diseases include drugs, cognitive-behavioral therapy, and somatic interventions, among others, but often, the evidence-based efficacy is limited and the results are highly variable. Here, we review recent research on the diagnosis and treatment of depression in the context of Alzheimer's disease, Parkinson's disease, and strokes, with the aim of identifying common approaches and solutions for its initial management by the neurologist.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Correspondence:
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital and Biomedical Research Institute, 15006 La Coruña, Spain
| | - Samuel Díaz
- Headaches Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Sagrario Manzano
- Department of Neurology, Infanta Leonor University Hospital, 28031 Madrid, Spain
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14
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D'souza J, Biswas A, Gada P, Mangroliya J, Natarajan M. Barriers leading to increased disability in neurologically challenged populations during COVID-19 pandemic: a scoping review. Disabil Rehabil 2022; 44:7693-7706. [PMID: 34666575 DOI: 10.1080/09638288.2021.1986747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The objective of this scoping review was to get an overview of barriers emerging across the globe from the pandemic that are likely to increase the level of pre-existing disability status of neurologically challenged populations. METHODS Database searches (PubMed/MEDLINE, CINAHL, ProQuest, Ovid, Scopus, and Web of Science) updated to December 2020 were conducted. Articles that identified challenges or barriers to neuro-rehabilitation, impact on disability status and health care services were included. Full-text articles limited to the English language with no restrictions on study design were included. Data was synthesized based on recurrent themes that were identified. RESULTS Thirty-seven studies were included in this review. Neurological populations considered: stroke, multiple sclerosis, amyotrophic lateral sclerosis, parkinson's disease, autism, developmental disabilities, and those who required neurosurgical care. Barriers were grouped into categories as increased disease risk and complications, delayed or restricted access to neuro-rehabilitation, limited hospital access, telerehabilitation limitations, and shutdown of special centers of aid. CONCLUSIONS COVID-19 pandemic has given rise to barriers that affect almost every aspect of healthcare and rehabilitation in neurologically challenged populations prompting an increase in their disability level. This can assist policymakers in designing mitigation strategies to minimize the detrimental effects on this vulnerable population.Implications for rehabilitationPandemic has led to the worsening of existing motor and non-motor symptoms, which need to be monitored, assessed and managed medically, and through rehabilitation in neurologically challenged populations.Notable decline of cognition and physical activity in neurologically challenged populations needs to be assessed and efforts to reverse these outcomes should be attempted.Rehabilitation services, hospital care and centers of aid need to be made more accessible for neurologically challenged populations with COVID-19 precautionary measures.Telemedicine and telerehabilitation need to be upgraded to enhance further face to face like interactions and for tracking of progressive disease.
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Affiliation(s)
- Jennifer D'souza
- Department of Physiotherapy, St. John's Medical College, Unit of St. John's National Academy of Health Sciences, Bangalore, India
| | - Arunima Biswas
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Pooja Gada
- Healing Touch Physiotherapy Clinic, Vasai (W), India
| | | | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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15
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Meskers CGM, van der Veen S, Kim J, Meskers CJW, Smit QTS, Verkijk S, Geleijn E, Widdershoven GAM, Vossen PTJM, van der Leeden M. Automated recognition of functioning, activity and participation in COVID-19 from electronic patient records by natural language processing: a proof- of- concept. Ann Med 2022; 54:235-243. [PMID: 35040376 PMCID: PMC8774059 DOI: 10.1080/07853890.2021.2025418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To address the feasibility, reliability and internal validity of natural language processing (NLP) for automated functional assessment of hospitalised COVID-19 patients in key International Classification of Functioning, Disability and Health (ICF) categories and levels from unstructured text in electronic health records (EHR) from a large teaching hospital. MATERIALS AND METHODS Eight human annotators assigned four ICF categories to relevant sentences: Emotional functions, Exercise tolerance, Walking and Moving, Work and Employment and their ICF levels (Functional Ambulation Categories for Walking and Moving, metabolic equivalents for Exercise tolerance). A linguistic neural network-based model was trained on 80% of the annotated sentences; inter-annotator agreement (IAA, Cohen's kappa), a weighted score of precision and recall (F1) and RMSE for level detection were assessed for the remaining 20%. RESULTS In total 4112 sentences of non-COVID-19 and 1061 of COVID-19 patients were annotated. Average IAA was 0.81; F1 scores were 0.7 for Walking and Moving and Emotional functions; RMSE for Walking and Moving (5- level scale) was 1.17 for COVID-19 patients. CONCLUSION Using a limited amount of annotated EHR sentences, a proof-of-concept was obtained for automated functional assessment of COVID-19 patients in ICF categories and levels. This allows for instantaneous assessment of the functional consequences of new diseases like COVID-19 for large numbers of patients.Key messagesHospitalised Covid-19 survivors may persistently suffer from low physical and mental functioning and a reduction in overall quality of life requiring appropriate and personalised rehabilitation strategies.For this, assessment of functioning within multiple domains and categories of the International Classification of Function is required, which is cumbersome using structured data.We show a proof-of-concept using Natural Language Processing techniques to automatically derive the aforementioned information from free-text notes within the Electronic Health Record of a large academic teaching hospital.
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Affiliation(s)
- Carel G. M. Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Sabina van der Veen
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jenia Kim
- Computational Lexicology and Terminology Lab, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline J. W. Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Quirine T. S. Smit
- Computational Lexicology and Terminology Lab, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stella Verkijk
- Computational Lexicology and Terminology Lab, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Guy A. M. Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Piek T. J. M. Vossen
- Computational Lexicology and Terminology Lab, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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16
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Abuadas FH, Ayasrah SM, Ahmad MM, Abu‐Snieneh H, Obiedallah HF, Basheti IA. Prevalence of depression and its associated factors among stroke survivors in Saudi Arabia. Nurs Open 2022; 10:1629-1638. [PMID: 36266745 PMCID: PMC9912400 DOI: 10.1002/nop2.1417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/06/2022] [Accepted: 10/02/2022] [Indexed: 02/11/2023] Open
Abstract
AIM The purpose of this study was to investigate the prevalence of poststroke depression (PSD) in Saudi Arabia and its association with socio-demographic and clinical factors. DESIGN A predictive correlational cross-sectional study. METHODS The study adopted a non-probability convenience sampling method to recruit 211 stroke survivors between April and October 2021 from the neurology outpatient departments of two main governmental hospitals in Saudi Arabia. PSD was measured using a self-assessment reliable and valid scale (The Hospital Anxiety and Depression Scale [HADS]). RESULTS More than two-thirds (70.6%) of the study sample (Mean age = 53 years, SD = 8.5, 51.2% were males) experienced some degree of depression (Score ≥8); of these, approximately half (48.8%) were in severe depression. The final prediction model was statistically significant (χ2 [15] = 31.39, p ˂ .01). PSD is a statistically significant health issue and requires immediate attention by healthcare providers to improve the health outcomes of stroke survivors.
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Affiliation(s)
- Fuad H. Abuadas
- College of Nursing, Community Health Nursing DepartmentJouf UniversitySakakaSaudi Arabia
| | - Shahnaz M. Ayasrah
- Department of Applied Science/NursingAl‐Balqa Applied UniversityAl‐SaltJordan
| | - Muayyad M. Ahmad
- Clinical Nursing Department, School of NursingUniversity of JordanAmmanJordan
| | | | - Hayyaf F. Obiedallah
- College of Nursing, Nursing Administration & Education DepartmentJouf UniversitySakakaSaudi Arabia
| | - Iman A. Basheti
- Dean ‐ Faculty of PharmacyApplied Science Private UniversityAmmanJordan
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17
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Ayasrah S, Ahmad M, Basheti I, Abu-Snieneh HM, Al-Hamdan Z. Post-stroke Anxiety Among Patients in Jordan: A Multihospital Study. J Geriatr Psychiatry Neurol 2022; 35:705-716. [PMID: 34933575 DOI: 10.1177/08919887211060015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the prevalence, correlates, and significant associated factors of anxiety among patients with stroke. A cross-sectional, correlation design was utilized. The Hospital Anxiety and Depression scale was used to detect and assess the severity of anxiety and depression among mentally well patients at general hospital settings. Among the 226 patients with stroke, 45.6% had clinically significant levels of anxiety to be considered as a definite case. Having a short duration since the stroke onset, being a definite case of depression, being unable to perform self-care activities, having an insufficient monthly income, and having visual problems due to stroke were the significantly associated factors. The high prevalence of anxiety among patients with stroke highlights the need for interventions of early detection and management to enhance recovery. Patients who have any of the significant traits predicted post-stroke anxiety required special attention.
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Affiliation(s)
| | | | - Iman Basheti
- 59177Applied Science Private University, Amman, Jordan
| | - Hana M Abu-Snieneh
- Faculty of Nursing, 84977Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Zaid Al-Hamdan
- 37251Jordan University of Science and Technology, Irbid, Jordan
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18
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Jaroonpipatkul C, Onwanna J, Tunvirachaisakul C, Jittapiromsak N, Rakvongthai Y, Chutinet A, Supasitthumrong T, Maes M. Depressive symptoms due to stroke are strongly predicted by the volume and location of the cerebral infarction, white matter hyperintensities, hypertension, and age: A precision nomothetic psychiatry analysis. J Affect Disord 2022; 309:141-150. [PMID: 35430315 DOI: 10.1016/j.jad.2022.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/24/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To delineate the effects of white matter hyperintensities (WMHs) as measured by Fluid-attenuated inversion recovery (FLAIR) and infarction volume as measured by Diffusion-weighted imaging (DWI) on post-stroke depression symptoms. METHODS Baseline National Institutes of Health Stroke Score (NIHSS) and Modified Rankin Scale (mRS) scores, and FLAIR and DWI MRIs to assess WMHs and acute infarct volumes, respectively, were assessed in 47 patients (≥55 years) with acute ischemic stroke and 17 normal controls. The Montgomery-Åsberg Depression Rating Scale (MDRS) was assessed three months after the stroke. RESULTS The MADRS score was significantly increased in stroke patients as compared with normal controls. The MADRS scale is not unidimensional and cannot be used as an accurate indicator of depression severity in stroke patients. Three months after stroke, key depressive (sadness and inability to feel) and concentration-tension symptoms, and lassitude are significantly predicted by the infarct volume. Right side infarction strongly predicts key depressive symptoms and left side infarction strongly predicts concentration-tension and lassitude scores. Total WMHs significantly predict key depressive and concentration-tension symptoms, and lassitude, with these effects being mediated by right and left DWI stroke volumes and associated disabilities. CONCLUSIONS Interactions between age, hypertension, a chronic atherosclerotic process, and acute stroke account for the onset of key depressive symptoms three months after the acute infarct. Chronic and acute neuro-immune and neuro-oxidative stress pathways associated with the formation of WMHs and acute stroke may explain the incidence of post-stroke key depressive and concentration-tension symptoms, and lassitude.
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Affiliation(s)
| | - Jaruwan Onwanna
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | | | | | - Yothin Rakvongthai
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Center, Deakin University, Geelong, Australia
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19
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Abstract
Long COVID refers to the lingering symptoms which persist or appear after the acute illness. The dominant long COVID symptoms in the two years since the pandemic began (2020-2021) have been depression, anxiety, fatigue, concentration and cognitive impairments with few reports of psychosis. Whether other symptoms will appear later on is not yet known. For example, dopamine-dependent movement disorders generally take many years before first symptoms are seen. Post-stroke depression and anxiety may explain many of the early long COVID cases. Hemorrhagic, hypoxic and inflammatory damages of the central nervous system, unresolved systematic inflammation, metabolic impairment, cerebral vascular accidents such as stroke, hypoxia from pulmonary damages and fibrotic changes are among the major causes of long COVID. Glucose metabolic and hypoxic brain issues likely predispose subjects with pre-existing diabetes, cardiovascular or lung problems to long COVID as well. Preliminary data suggest that psychotropic medications may not be a danger but could instead be beneficial in combating COVID-19 infection. The same is true for diabetes medications such as metformin. Thus, a focus on sigma-1 receptor ligands and glucose metabolism is expected to be useful for new drug development as well as the repurposing of current drugs. The reported protective effects of psychotropics and antihistamines against COVID-19, the earlier reports of reduced number of sigma-1 receptors in post-mortem schizophrenic brains, with many antidepressant and antipsychotic drugs being antihistamines with significant affinity for the sigma-1 receptor, support the role of sigma and histamine receptors in neuroinflammation and viral infections. Literature and data in all these areas are accumulating at a fast rate. We reviewed and discussed the relevant and important literature.
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20
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Ozkan H, Ambler G, Banerjee G, Chan E, Browning S, Mitchell J, Perry R, Leff AP, Simister RJ, Werring DJ. The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison. J Neurol 2022; 269:1741-1750. [PMID: 34652502 PMCID: PMC8517937 DOI: 10.1007/s00415-021-10819-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. METHODS This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March-16th May 2018 (pre-COVID-19 pandemic); and 16th March-16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System-29 (PROMIS-29 version 2.0) at 30 days after stroke. RESULTS We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001). CONCLUSION Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health.
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Affiliation(s)
- Hatice Ozkan
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, UK
| | - Gargi Banerjee
- MRC Prion Unit at UCL, Institute of Prion Diseases, University College London, London, UK
| | - Edgar Chan
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
- Neuropsychology Department, National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK
| | - Simone Browning
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK
| | - John Mitchell
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Richard Perry
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK
| | - Alex P Leff
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK
| | - Robert J Simister
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK
| | - David J Werring
- Stroke Research Centre, Queen Square Institute of Neurology, University College London, London, UK.
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Institute of Neurology, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N, UK.
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21
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Wang JM, Liu Z, Liu H. Clinical Observation of Comfort Nursing Combined With Continuous Nursing Intervention After Discharge on Improving Pressure Ulcers, Falls, Quality of Life, and Prognosis in Patients With Intracerebral Hemorrhage. Front Surg 2022; 8:829227. [PMID: 35178427 PMCID: PMC8843830 DOI: 10.3389/fsurg.2021.829227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
In this prospective study, we randomly divided 131 patients with intracerebral hemorrhage (ICH) who met the inclusion criteria into two groups. One group received routine nursing during hospitalization, and the “Stroke Prevention Knowledge Manual” was issued before discharge, and was recorded as the control group (n = 61); one group received comfort nursing during hospitalization, and implemented continuous nursing after discharge, and was recorded as the research group (n = 70). The indicators we observed were the occurrence of pressure ulcers and falls during the hospitalization of the two groups of patients and the improvement in neurological function, limb function, quality of life, ability of daily living, and emotional state after the intervention. We also compared the disability degree of the two groups 6 months after discharge, the readmission status within 6 months of discharge, and the nursing satisfaction after the intervention. Our conclusion is that comfort nursing combined with continuous nursing intervention after discharge can effectively reduce the occurrence of pressure ulcers and falls during the nursing period of patients with ICH and contribute to the improvement of their quality of life and prognosis. It is worthy of clinical promotion.
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Affiliation(s)
- Ji Min Wang
- Department of Traditional Chinese Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Zhen Liu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Hongxia Liu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- *Correspondence: Hongxia Liu
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22
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Qinlin F, Qi X, Qiong C, Lexing X, Peixia S, Linlin H, Yupu D, Lijun Y, Qingwu Y. Differential expression analysis of microRNAs and mRNAs in the mouse hippocampus of post-stroke depression (PSD) based on transcriptome sequencing. Bioengineered 2022; 13:3582-3596. [PMID: 35100085 PMCID: PMC8973717 DOI: 10.1080/21655979.2022.2027061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
To clarify the differential expressions of microRNAs and mRNAs in a PSD model, this study employed PSD mice for model construction by injecting vasoconstrictor ET-1 (angioendothelin-1) into the medial prefrontal cortex (mPFC) of mice. The animals underwent elevated plus maze test, open field test, tail suspension test, and forced swimming test subsequently. Transcriptome sequencing was performed to analyze the differentially expressed mRNAs and microRNAs. The results showed that open arm entries and time of PSD mice were markedly decreased. Times of the entry to center for mice in the model group were apparently decreased. The climbing time of mice in the model group was greatly decreased. The behavior of PSD mice indicated a marked change, and several indicators of the behavioral tests were significantly lower than those of the control group. Transcriptome sequencing analysis demonstrated that expressions of 1 206 genes and 21 microRNAs were markedly upregulated in model group, whereas expressions of 2 113 genes and 32 microRNAs were markedly downregulated. GO analysis revealed that the differentially expressed genes were mainly involved in regulatory pathways of single-multicellular organism process, developmental process, cell periphery, plasma membrane, and neuron projection. Meanwhile, KEGG analysis results indicated that the differentially expressed genes mostly participated in signaling pathways of neuroactive ligand-receptor interaction, calcium signaling pathway, and cytokine-cytokine receptor interaction. In conclusion, differentially expressed microRNAs and mRNAs were screened, which offers a theoretical foundation for further investigation of molecular mechanisms and novel insight for the early identification, prevention, and treatment of PSD.
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Affiliation(s)
- Fan Qinlin
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xie Qi
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chen Qiong
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xie Lexing
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shi Peixia
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hu Linlin
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Diao Yupu
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yang Lijun
- Chongqing Public Health Medical Treatment Center, Chongqing, China
| | - Yang Qingwu
- Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
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23
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Bi H, Wang M. Role of social support in poststroke depression: A meta-analysis. Front Psychiatry 2022; 13:924277. [PMID: 36213910 PMCID: PMC9539912 DOI: 10.3389/fpsyt.2022.924277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Poststroke depression significantly affects health and quality of life of stroke patients. This study evaluates the role of social support in influencing poststroke depression. The literature search was conducted in electronic databases and study selection was based on precise eligibility criteria. The prevalence rates reported by individual studies were pooled. A meta-analysis of standardized mean differences (SMD) in social support between depressed and non-depressed stroke patients was performed. The odds ratios and correlation coefficients showing the relationship between social support and depression were pooled to achieve overall estimates. Twenty-five studies (9431 patients) were included. The prevalence of depression was 36% [95% confidence interval (CI): 28, 45]. Patients with poststroke depression had significantly lower social support in comparison with patients with no or lower levels of depression [SMD in social support scores -0.338 (95% CI: -0.589, -0.087); p = 0.008]. The odds of depression were lower in patients receiving higher levels of social support [OR 0.82 (95% CI: 0.69, 0.95)] but were higher in patients who were receiving weaker social support [OR 5.22 (95% CI: -0.87, 11.31)]. A meta-analysis of correlation coefficients found a significantly inverse correlation between social support and poststroke depression [r -0.336 (95% CI: -0.414, -0.254)]. Poststroke depression has a significant independent inverse association with social support.
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Affiliation(s)
- Haiyang Bi
- Department of Acupuncture, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Mengjia Wang
- Integrated Traditional Chinese and Western Medicine Rehabilitation Medical Center, Heilongjia Provincial Hospital, Harbin, China
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24
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Thambirajah N, Senanayake S, Gooneratne K, Suraweera C, Ranasinghe L, Kumbukage M. Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka. J Neurosci Rural Pract 2022; 13:73-79. [PMID: 35110923 PMCID: PMC8803510 DOI: 10.1055/s-0041-1741504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background and Objectives The prevalence of stroke in urban Sri Lanka is estimated at 10.4 per 1000 and is expected to rise. Post-stroke depression (PSD) is an independent predictor of poor long-term outcomes. It leads to suboptimal rehabilitation, decreased quality of life, and increased mortality and is under-recognized. The main objectives of this study were to estimate the prevalence of depression in stroke, assess factors associated with PSD, and assess the relationship of PSD to disability. Materials and Methods A descriptive cross-sectional study was conducted at the Neurology and Medical Ward, National Hospital of Sri Lanka. Non-probability, consecutive sampling was used to collect data from patients with ischemic stroke admitted from January 2019 to January 2020. Patients with significant pre-existing depression, cognitive impairment, and language deficits were excluded. A structured, pre-tested interviewer-administered questionnaire was used to assess the prevalence and associated factors of PSD. Beck's Depression Inventory (BDI) was administered 3 months following the stroke to screen for depression. Modified Rankin Score (MRS) was used to assess disability on admission, discharge, and at 3 months. Results Eighty-one stroke patients were screened. The mean age was 66.6 years (±standard deviation [SD]: 12.5). Male:female ratio was 1.2:1. Depression at 3 months of follow-up was observed in 35.8% (95% confidence interval [CI]: 25.4-47.2%) of participants. Following bivariate analysis, large vessel stroke ( p < 0.001), cortical stroke ( p < 0.001), frontal lobe lesions ( p < 0.001), history of past stroke ( p = 0.014), and sexual dysfunction ( p = 0.026) were associated with increased risk of PSD. The odds of a person with severe disability developing PSD was 7.9 times more than a person with a less severe disability at discharge from hospital and at 3 months of follow-up (odds ratio [OR] =7.9; 95% CI: 2.7-23.3, p = 0.000). Conclusions PSD occurs in one-third of strokes, keeping with previous studies. The risk of having PSD is higher among patients with severe disabilities. The difference in risk factors identified compared with previous studies can be attributable to differences in methodology. Identifying risk factors for post-stroke depression is essential to mitigate the poor outcome.
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Affiliation(s)
| | - Sunethra Senanayake
- National Hospital Sri Lanka, District General Hospital Hambanthota, Faculty of Medicine, University of Moratuwa, Moratuwa, Sri Lanka
| | - Kishara Gooneratne
- National Hospital Sri Lanka, District General Hospital Hambanthota, Faculty of Medicine, University of Moratuwa, Moratuwa, Sri Lanka
| | - Chaturi Suraweera
- Department of Psychiatry, Faculty of Medicine, National Hospital of Sri Lanka, University of Colombo, Colombo, Sri Lanka
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25
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Li M, Wang Y, Li K, Xu X, Zhuang L. The efficacy and safety of Jin's three-needle therapy vs. placebo acupuncture on anxiety symptoms in patients with post-stroke anxiety: A study protocol for a randomized controlled trial. Front Psychiatry 2022; 13:941566. [PMID: 36159932 PMCID: PMC9490304 DOI: 10.3389/fpsyt.2022.941566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A large number of clinical RCTs have verified that Jin's three-needle therapy (JTNT) has a great contribution to promoting the function of paralyzed limbs and relieving anxiety disorders for patients with post-stroke anxiety (PSA). However, there is still a lack of sham needle control, and its placebo effect cannot be ruled out. This study firstly verifies the real effectiveness of JTNT. Besides, the changes in serum indexes on the hypothalamic-pituitary-adrenal axis (HPA axis) are observed dynamically by the Enzyme-Linked ImmunoSorbent Assay (ELISA). The activation of different brain regions by JTNT is recorded using resting functional magnetic resonance imaging (rs-fMRI). Therefore, we can provide more practical and powerful evidence-based medical evidence for clinical decisions. METHOD This is a 16 week parallel, single-blind, random, controlled trial, including baseline, 4 weeks of treatment, and 12 weeks of follow-up. A total of 114 participants will be randomly divided into three groups in the proportion of 1:1:1. Participants will receive Jin's three-needle therapy in the active acupuncture group and accept sham needle treatment in the sham acupuncture group. In the waitlist control group, patients will not receive any acupuncture treatment. Outcomes cover three types of indicators, including scale indicators, serum indicators, and imaging indicators. The primary outcome is the change in the performance of anxiety symptoms, which is estimated by the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and the 7-item Generalized Anxiety Disorder scale (GAD-7). Secondary outcomes are physical recovery and daily quality of life, which are evaluated by the National Institute of Health stroke scale (NIHSS) and the Modified Barthel Index Score (MBI Scale). Therefore, the assessment of the scale is carried out at baseline, 2nd, 4th, 8, 12, and 16 weeks. Adrenocorticotropin and cortisol will be quantitatively detected by ELISA at baseline and 4 weeks after treatment. In addition, regional homogeneity analysis (ReHo) will be used to record the activity of brain regions at baseline and 4 weeks after intervention. DISCUSSION The study aims to provide high-quality clinical evidence on the effectiveness and safety of JTNT for patients with PSA. In addition, this trial explores a possible mechanism of JTNT for patients with PSA. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier [ChiCTR2200058992].
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Affiliation(s)
- Meichen Li
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuting Wang
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Keyi Li
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Xu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixing Zhuang
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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26
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Chou HY, Lo YC, Tsai YW, Shih CL, Yeh CT. Increased Anxiety and Depression Symptoms in Post-Acute Care Patients with Stroke during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:162. [PMID: 35010420 PMCID: PMC8751212 DOI: 10.3390/ijerph19010162] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
This study aimed to explore the quality and stability of post-acute care for patients with stroke, including their functional outcomes, mental health and medical care in Taiwan during the COVID-19 pandemic. In this retrospective case-control study-based on propensity score matching-we assessed 11 patients admitted during the pandemic period (in 2021) and 11 patients admitted during the non-pandemic period (in 2020). Functional outcomes, including the scores of the modified Rankin Scale, Barthel Index, EuroQoL-5 Dimension, Lawton-Brody instrumental activities of daily living, Berg Balance Scale, 5-metre walking speed and 6-min walking distance, were determined. Data on the length of acute care, length of post-acute care, destination after discharge and 14-days readmission were used to evaluate the quality of medical care. The Wilcoxon signed-rank test was used to compare functional performance before and after rehabilitation. The pandemic group showed no significant improvement in the scores of EuroQoL-5 Dimension, a self-reported health status assessment (p = 0.13), with the anxiety or depression dimension showing a negative effect (r = 0.21). Post-acute care programmes can efficiently improve the functional performance of patients with stroke during the COVID-19 pandemic in Taiwan. Mental health should therefore be simultaneously maintained while rehabilitating physical function.
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Affiliation(s)
- Hsiang-Yun Chou
- Department of Rehabilitation, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Yu-Chun Lo
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan;
| | - Ya-Wen Tsai
- Department of Rehabilitation, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Chia-Li Shih
- Department of Rehabilitation, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Chieh-Ting Yeh
- Department of Nursing, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
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27
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Mahadevan S, Chan MF, Moghadas M, Shetty M, Burke DT, Al-Rasadi K, Al-Adawi S. Post-Stroke Psychiatric and Cognitive Symptoms in West Asia, South Asia and Africa: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:3655. [PMID: 34441951 PMCID: PMC8397184 DOI: 10.3390/jcm10163655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022] Open
Abstract
Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery-Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.
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Affiliation(s)
- Sangeetha Mahadevan
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Marzieh Moghadas
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - Maithili Shetty
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - David T. Burke
- Department of Rehabilitation Medicine in the Emory University School of Medicine, 1441 Clifton Road N.E., Atlanta, GA 30322, USA;
| | - Khalid Al-Rasadi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
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28
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Yao M, Li H, Luo Y, Li L, Yu J. High Prevalence of Post-stroke Anxiety in Elderly Patients Following COVID-19 Outbreak. Front Psychiatry 2021; 12:699869. [PMID: 34248720 PMCID: PMC8264416 DOI: 10.3389/fpsyt.2021.699869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: Post-stroke anxiety (PSA) is a common affective disorder in patients with ischemic stroke. The elderly are more susceptible to mental health issues, however, few studies have so far focused on PSA in elderly patients, especially in the context of the COVID-19, causing psychological issues in the general population. The aim of the present study was to assess the prevalence and risk factors of PSA in elderly patients following COVID-19 outbreak. Methods: We retrospectively analyzed 206 elderly inpatients with newly diagnosed acute ischemic stroke in the First Affiliated Hospital, Sun Yat-sen University, from January 2020 to December 2020. Patients were categorized into the PSA group and the non-PSA group based on Hamilton Anxiety Scale scores at admission (within 1 week after stroke onset). Demographic and clinical data, mental state by Mini-Mental State Examination, depression by Hamilton Depression Scales (HAMD), and stroke severity and outcome by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale were compared between the two groups. Univariate analysis and binary logistic regression analysis were used to analyze risk factors associated with PSA. We determined the cutoff scores for significant predictors of PSA using the area under the curve (AUC) and receiver operating characteristic. Results: Of the 206 stroke patients, 62 (30.1%) developed anxiety. Binary logistic regression analysis showed that female gender [adjusted odds ratio (aOR): 2.288, 95% confidence interval (CI):1.021-5.128, P = 0.044], high NIHSS scores [aOR: 1.264, 95% CI: 1.074-1.486, P = 0.005] and HAMD scores [aOR: 1.345, 95% CI: 1.215-1.490, P < 0.001] were independent risk factors for PSA. The cutoff threshold for the NIHSS scores was 3.5 points with an AUC of 0.64 and the cutoff threshold for HAMD scores was 5.5 points with an AUC of 0.89. Conclusion: Our results showed a high incidence of PSA in elderly patients after the COVID-19 outbreak. Female gender, high NIHSS and HAMD scores were the independent risk factors for PSA.
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Affiliation(s)
- Meiling Yao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hongjie Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Ying Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Ling Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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